Provider Demographics
NPI:1578782413
Name:DANZIGER, FRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:DANZIGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SEVEN FARMS DR
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8107
Mailing Address - Country:US
Mailing Address - Phone:843-284-4444
Mailing Address - Fax:843-377-8499
Practice Address - Street 1:324 WEST PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3213
Practice Address - Country:US
Practice Address - Phone:516-432-2837
Practice Address - Fax:516-432-6319
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist